Healthcare Provider Details

I. General information

NPI: 1265925895
Provider Name (Legal Business Name): AYANNA NONI BLEVINS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 06/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 FULTON ST
DURHAM NC
27705-3875
US

IV. Provider business mailing address

302 ALLENDOWN LN
KNIGHTDALE NC
27545-6735
US

V. Phone/Fax

Practice location:
  • Phone: 919-286-0411
  • Fax:
Mailing address:
  • Phone: 919-440-4340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number304327
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: